CHAPTER 4: SCREENING FOR CERVICAL CANCER

Chapter 5: Diagnosis and Management of Precancer 141cytological tests. With screening tests that provide immediate results, such as VIA andVILI, screening and treatment can be provided during a single hospital visit. However, asecond visit might be needed in the following circumstances:• The patient is menstruating heavily, is pregnant or needs treatment for PID.• The therapy available is not appropriate for the lesion.• Treatment is not available at the same site and the patient needs to be referred toanother facility.• The client prefers to discuss the treatment with her partner before proceeding.• The client needs further evaluation.Studies and pilot projects using the screen-and-treat approach have mainly focusedon the use of visual tests for screening and cryotherapy for treatment, because of theadvantages of a single-visit approach that can be decentralized to primary care level.A flowchart for this approach is given in Annex 4b. It is important tonote that the impact of the screen-and-treat approach on the incidenceAnnexand mortality of invasive cervical cancer is not yet known. Therefore, 4bif this approach is implemented in countries, careful monitoring andScreen and treatevaluation must be carried out.5Chapter 5: Diagnosis and Management of PrecancerAdvantages and limitations of the screen-and-treat approachAdvantages• Infrastructure and equipment aresimpler and less costly, and providerlevel lower• Single-visit approach reduces lossto follow-up and treatment, resultingin a reduced burden of tracking andcontacting women• Lowers burden for women byreducing the number of visits• Highly acceptable to women andprovidersLimitations• Impact on cervical cancer incidenceand mortality not yet known• Important ethical and resource useconcerns, including overtreatment andundertreatment 13• No specimen available for laterevaluation, unless biopsy taken beforetreatment13 Overtreatment is treatment of women who do not have disease. If specificity of VIA is 85%, about15% of women screened would be treated on the basis of false positive results, wasting resourcesand increasing exposure to potential risks and side-effects. Undertreatment occurs if women withinvasive disease or disease within the endocervical canal are treated with cryotherapy.